Tresiba to Levemir conversion guidelines are presented here to help readers easily switch between the two commonly used basal insulins.
Tresiba to Levemir and Levemir to Tresiba Conversion Guidelines are simplified versions of the ADA (American Diabetes Association) recommendations.
Since these recommendations primarily focus on minimizing hypoglycemia, switching from one insulin to another might cause the blood sugars to fluctuate.
For this reason, once you have switched to another insulin, you should frequently monitor your blood glucose and adjust your dose.
What is Tresiba?
Tresiba is an ultra-long-acting insulin analog. It contains Insulin Degludec that provides basal insulin cover when administered.
The basal insulin cover of insulin Degludec is similar to other basal long-acting insulins including Insulin Glargine (Insulin Toujeo) and Insulin Levemir (Detemir).
Most basal insulins, including Insulin Degludec, primarily lower the pre meals and fasting blood glucose.
Henceforth, basal insulins are usually combined with prandial short-acting insulins or oral diabetes medications.
Compared to Insulin Detemir (Levemir) and Insulin Glargine (Lantus and Toujeo), Insulin Degludec (Tresiba) has the longest half-life. It has a half-life of about 25 hours and the duration of insulin Degludec lasts for about 24 hours after a single dose injection.
Because of its very long half-life and duration of action, it can be administered at any time of the day.
Other basal insulins like Insulin Detemir (Levemir) and Insulin Glargine (Lantus, Toujeo, and Basaglar) have to be administered at a fixed time of a day.
Insulin Tresiba is also available in combination with Insulin Aspart by the brand name of Insulin Ryzodeg. It is also available in combination with Injection Liraglutide by the brand name of Xultophy.
What is Insulin Levemir?
Insulin Levemir, like Insulin Degludec, is also a long-acting basal insulin. It contains Insulin Detemir. Among the three basal insulins, Insulin Degludec, Insulin Glargine, and Insulin Detemir, it has the shortest half-life.
The half-life of insulin Detemir (Levemir) is about 7 hours. The duration of action of Levemir is about 24 hours. The duration of action ranges between 5.7 hours to 23.2 hours depending on the dose administered [Ref].
The maximum bioavailability of insulin detemir is about 68%. The peak serum concentration of insulin Levemir is usually observed after 6 to 8 hours of its administration.
Tresiba to Levemir Conversion Dosing Guidelines as per the ADA, European Diabetes Association, & JDRF) [Ref]:
Insulin Degludec (Tresiba) is true long-acting insulin and may be administered any time of the day, however, some patients may prefer using Insulin Levemir. The benefits of Insulin Levemir over Tresiba are:
- Insulin Levemir is cheaper than Insulin Degludec
- Insulin Levemir is associated with less weight gain compared to Insulin Degludec.
When switching from Tresiba to Levemir or Levemir to Tresiba, most guidelines recommend reducing the dose by 20% of the initial basal insulin. However, a 20% dose reduction is advised to minimize the risks of hypoglycemia.
If the baseline glycated hemoglobin exceeds 8% or the fasting and random blood sugars are not controlled, a 20% dose reduction is not necessary. In such cases, the same dose of the initial baseline insulin should be used.
Insulin Tresiba to Levemir Conversion Guidelines
|When switching from Tresiba to Levemir, guidelines recommend reducing the dose by 20%.
If the dose of Tresiba used was less than 80 units per day, after a 20% reduction in the dose, the total insulin Levemir can be administered once daily.
However, if the dose of Insulin Tresiba was 80 units or more per day, it is recommended to reduce the dose by 20% and divide the remaining insulin dose into two equal halves.
Each half dose of insulin Levemir can then be administered twice daily.
|Example 1||A person is using 60 units of insulin Tresiba per day||How to switch from Tresiba to Levemir?||First, reduce the dose by 20%. This will be equal to 48 units.
Administer 48 units of insulin Levemir once daily
|Example 2||A person is using 90 units of insulin Tresiba per day||How to switch from Tresiba to Levemir?||First, reduce the dose by 20%. This will be equal to 72 units.
Divide 72 units into two equal doses i.e. 36 units.
Administer 36 units of insulin Levemir twice daily.
Insulin Levemir to Tresiba Conversion Guidelines and Dose Calculation with Examples:
Insulin Levemir to Tresiba conversion or vice versa is a common practice. Levemir insulin is not considered a true long-acting basal insulin because of its relatively shorter half-life and shorter duration of action.
Furthermore, Tresiba is peakless insulin and less likely to be associated with hypoglycemia compared to Insulin Detemir (Levemir). Hence, insulin Tresiba may be preferred in the following situations:
- Patients who desire a single injection
- When hypoglycemia is a risk such as the elderly and those with organ dysfunction like liver or renal disease
- Patients requiring high doses of insulin.
Insulin Levemir to Tresiba Conversion Guidelines
|When switching from Levemir (Detemir) to Tresiba (Degludec), opinions differ. The ADA and European guidelines recommend reducing the dose by 20%.
After 20% dose reduction, the dose is then administered once daily.
However, UpToDate recommends using Insulin Tresiba in the same dose as Insulin Levemir i.e. no dose reduction is recommended.
|Example 1||A person is using 40 units of insulin Levemir per day||How to switch from Levemir to Tresiba?||First, reduce the dose by 20%. This will be equal to 32 units.
Administer 32 units of insulin Levemir once daily.
(See Notes Below)
|Example 2||A person is using 40 units of insulin Levemir two times a day (total 80 units per day)||How to switch from Levemir to Tresiba?||First, reduce the dose by 20%. This will be equal to 64 units.
Administer 64 units of Insulin Tresiba as a once-daily injection
|20% dose reduction is not recommended as per UpToDate guidelines. Furthermore, if a person has uncontrolled fasting or random blood glucose or the glycated hemoglobin is 8% or more, dose reduction is not recommended. The same dose of insulin Tresiba should be used as Insulin Levemir.|
Points to Remember:
All basal insulins slightly differ in terms of their efficacies and side effects. They lower the fasting and pre meals blood glucose which in turn have significant effects on the whole 24 hours of blood glucose. The major difference is the number of injections and the timings of insulin administration.
Tresiba is usually administered once daily without regard to meals and time. It can be injected at any time of the day.
Insulin Levemir is administered once daily at a fixed time of the day. However, if the dose of Insulin Levemir exceeds 60 to 80 units per day, the dose should be split into two equal doses and administered twice daily.
Patients with very good control of blood glucose can switch from Tresiba to Levemir or Levemir to Tresiba. To avoid hypoglycemia, the initial dose should be reduced by 20%.
If the blood sugars are uncontrolled, a 20% dose reduction is not recommended.